2025 ICD-10-CM code K51.913
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Gastrointestinal Disease - Ulcerative colitis, unspecified, with complications Diseases of the digestive system Feed
Ulcerative colitis, unspecified, with fistula.
Modifiers may be applicable depending on the circumstances of the encounter and the procedures performed. For example, modifiers may indicate the location of the service, the type of service, or the level of service.
Medical necessity is established based on symptoms consistent with ulcerative colitis, presence of a fistula confirmed by imaging or endoscopy, and the clinical judgment that treatment (medical or surgical) is required to manage the condition and its complications.Justification must include appropriate clinical documentation.
The clinical responsibility for this code would involve a gastroenterologist or a general surgeon, depending on the severity and management of the condition. The physician would perform a thorough evaluation, including a review of symptoms, medical history, physical examination, and diagnostic testing such as colonoscopy with biopsy, imaging studies (CT, MRI, etc.), and laboratory tests. Treatment may range from medical management (e.g., anti-inflammatory medications, immunomodulators, biologics) to surgical intervention for fistula repair or bowel resection.
In simple words: This code indicates a type of inflammatory bowel disease (ulcerative colitis) where the exact location in the large intestine isn't specified, but there's an added complication: an abnormal connection (fistula) between parts of the bowel or the bowel and another area like the skin.
This ICD-10-CM code signifies ulcerative colitis of unspecified location, complicated by the presence of a fistula.Ulcerative colitis is a chronic inflammatory bowel disease affecting the large intestine, causing inflammation and ulceration of the colonic mucosa. A fistula is an abnormal connection between two organs or vessels, in this case, likely connecting the bowel to another structure such as the skin or another part of the gastrointestinal tract.
Example 1: A 45-year-old female presents with chronic diarrhea, abdominal pain, and weight loss. Colonoscopy reveals pancolitis with a perianal fistula.Code K51.913 is assigned., A 60-year-old male with a history of ulcerative colitis develops a rectovaginal fistula. Code K51.913 is used, with additional codes to specify the location and type of fistula., A 30-year-old female undergoes a colectomy for severe ulcerative colitis. Post-operative imaging demonstrates a small bowel fistula. Code K51.913 is used, along with procedural codes and postoperative diagnosis codes.
Detailed history and physical examination findings, including location and duration of symptoms, description of fistula, results of colonoscopy with biopsy, imaging studies (if performed), and laboratory results.
** This code is used for ulcerative colitis cases where the location is unspecified, but a fistula is present.Further specificity regarding the location of the colitis and the type of fistula may require additional codes.
- Payment Status: Active
- Specialties:Gastroenterology, Colorectal Surgery, General Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office